Provider Demographics
NPI:1851558647
Name:FOX VALLEY SPEECH & SWALLOWING CENTER
Entity Type:Organization
Organization Name:FOX VALLEY SPEECH & SWALLOWING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOBULNICKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC
Authorized Official - Phone:630-898-2823
Mailing Address - Street 1:4255 WESTBROOK DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8125
Mailing Address - Country:US
Mailing Address - Phone:630-898-2823
Mailing Address - Fax:630-898-8423
Practice Address - Street 1:4255 WESTBROOK DR
Practice Address - Street 2:SUITE 208
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8125
Practice Address - Country:US
Practice Address - Phone:630-898-2823
Practice Address - Fax:630-898-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146000184261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech